Chapter 5 - Communicating Information

Question 1

ACEi in pregnancy for hypertension - solution?

Answer 1

Stop ACEi, replace with labetalol (BB)

Question 2

Combined HRT advice about breast cancer risk

Answer 2

Combined HRT has higher risk for breast cancer than oestrogen-only
The increased breast cancer risk persists for 10 years after stopping
The increased breast cancer risk is related to duration of use
Vaginal preps including low doses of oestrogen do NOT increase breast cancer risk

Question 3

Bisphosphonates advice

Answer 3

Given once weekly with a glass of water + remaining upright for 30 mins after, avoiding giving with food and calcium salts as reduce absorption
They reduce the risk of fragility fractures but will only prevent the minority of them (odds ratio >0.5 but <1 compared to placebo)

Question 4

Advice around T1DM glucose control (HbA1c duration, necessary insulin changes around illness, consequences of poor glycemic control, consequences of not rotating injection sites)

Answer 4

HbA1c gives an average glucose control over 3 months, pts should aim for ≤48mmol/mol
When unwell blood glucose increases so insulin doses need to do so as well, and when eating less vice versa
Poor glycemic control significantly increases risk of microvascular and microvascular complications
Not rotating injection sites leads to lipodystrophy (lipoma formation)

Question 5

How long can it take to improve symptoms for SSRIs?

Answer 5

Up to 6 weeks

Question 6

Precautions with citalopram and sunlight?

Answer 6

Makes you photosensitive so take more care in sunlight

Question 7

Critical safety net to tell patients starting SSRIs?

Answer 7

Any suicidal thoughts should prompt seeking help immediately, there are a small number of patients who will feel more suicidal after starting before they improve

Question 8

Symptoms of serotonin syndrome?

Answer 8

Agitation, hyperthermia, hallucinations = go to hospital immediately

Question 9

Mouth side effects of SSRIs?

Answer 9

Dry mouth

Question 10

Monitoring of warfarin on commencement?

Answer 10

Initially weekly blood tests
Once INR stable then monthly blood tests

Question 11

Colours and doses of warfarin tablets?

Answer 11

White = 0.5mg
Brown = 1mg
Blue = 3mg
Pink = 5mg

Question 12

When should gliclazide (and other oral hypoglycaemics) be taken?

Answer 12

In the morning with breakfast. Taking at night increases risk of nocturnal hypoglycaemia

Question 13

Advice about tamoxifen

Answer 13

Increases risk of endometrial cancer
Increases efficacy of warfarin so lower dose needed
Commonly causes hot flushes
IMPORTANT - increases risk of VTE